RAETTA LYNN WENTZ (NPI# 1740508779) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740508779 |
| Entity Type | Individual |
| Full Name | RAETTA LYNN WENTZ |
| Credential | PA-C |
| Practice Address |
1370 Johnson Ave Bridgeport WV 26330-1492 |
| Practice Telephone | 3048427186 |
| Practice Fax Number | 3048422533 |
| Mailing Telephone | 3048427186 |
| Mailing Fax Number | 3058422533 |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2010-05-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
00552 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1370 JOHNSON AVE |
| City | BRIDGEPORT |
| State | WV |
| Zip Code | 26330-1492 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619946936 | James J Demarco | Internal Medicine | 1370 Johnson Ave, Ste 203, Bridgeport, WV 26330-1378 | 2006-03-17 |
| 1962036509 | Maria Bridgette Scudere | Nurse Practitioner | 1370 Johnson Ave, Bridgeport, WV 26330-1492 | 2020-02-22 |
| 1841663127 | Carrie Renee Arbogast | Physician Assistant | 1370 Johnson Ave, Ste 102, Bridgeport, WV 26330-1492 | 2015-11-09 |
| 1750674149 | Tammy Lou Yazevac | Physician Assistant | 1370 Johnson Ave, Bridgeport, WV 26330-1492 | 2011-05-18 |
| 1023332699 | Jaclyn K Swick | Physician Assistant | 1370 Johnson Ave, Bridgeport, WV 26330-1492 | 2010-03-25 |
| 1750565800 | United Hospital Center, Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1370 Johnson Ave, Suite 201, Bridgeport, WV 26330-1492 | 2007-12-26 |
| 1578692679 | Medbrook Medical Assoc. Inc. | Clinical Medical Laboratory | 1370 Johnson Ave, Bridgeport, WV 26330-1382 | 2007-03-05 |
| 1720142391 | Timothy M Peasak | Emergency Medicine | 1370 Johnson Ave, 1st Floor, Bridgeport, WV 26330 | 2006-12-20 |
| 1649292228 | Medbrook Medical Associates Inc | Pharmacy | 1370 Johnson Ave, Bridgeport, WV 26330-1492 | 2006-07-24 |
| 1922065879 | Carol A Shirey | Internal Medicine | 1370 Johnson Ave, Ste 102, Bridgeport, WV 26330-1492 | 2006-04-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303036 | Gage Mackenzie Chichester | Nurse Anesthetist, Certified Registered | 2673 Medical Park Drive, Bridgeport, WV 26330 | 2020-10-12 |
| 1851914105 | Melany Langhurst | Social Worker | 64 Professional Place, Suite 102, Bridgeport, WV 26330 | 2020-05-21 |
| 1245704980 | Adam Christopher Stonestreet | Social Worker | Community Care of Bridgeport, 65 Professional Place, Bridgeport, WV 26330 | 2019-01-16 |
| 1588146658 | Bridgeport Physical Therapy Services, Inc. | Occupational Therapist | 25 Sweetbrier Lane, Suite 105, Bridgeport, WV 26330 | 2018-09-05 |
| 1275040685 | White Oaks Assisted Living | Assisted Living Facility | 140 Professional Place White Oaks, Bridgeport, WV 26330 | 2018-01-08 |
| 1275049371 | Regional Eye Associates, Inc | Ophthalmology | 220 Southview Drive, Bridgeport, WV 26330 | 2017-12-27 |
| 1528586187 | Savanna Tamia Brown | Social Worker | 65 Professinal Place Suites 101,102103, Bridgeport, WV 26330 | 2017-09-05 |
| 1184079642 | Karla Kay Rinehart | Social Worker | 27 Trovato St., Suite 103, Bridgeport, WV 26330 | 2016-05-03 |
| 1396176756 | Willo Group LLC | Pharmacy | 460 E. Main Street, Bridgeport, WV 26330 | 2013-12-10 |
| 1891031878 | Sherri Michelle Dobson | Occupational Therapy Assistant | 1000 Maplewood Dr, Bridgeport, WV 26330 | 2012-12-20 |
| Find all providers in zip 26330 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578024105 | Vance P Baughman | Physician Assistant | 325 Lafayette St Unit 1003, Bridgeport, CT 06604-5472 | 2019-03-27 |
| 1780178285 | Christina P. Filippakis | Physician Assistant | 401 Myrtle Ave, Bridgeport, CT 06604-5444 | 2018-06-18 |
| 1720134372 | Tommy Savedra | Physician Assistant | 221 Twin Lakes Rd, Bridgeport, CA 93517 | 2007-01-26 |
| 1235284886 | Patricia Lynn Ross | Physician Assistant | 104 Orchard Ave, Bridgeport, WV 26330-1736 | 2007-01-24 |
| 1609890789 | Kaufmann Leslie Kaufmann | Physician Assistant | 1 Lee Ann Ln, Bridgeport, WV 26330-1080 | 2006-07-26 |
| 1407477334 | Emily Nicole Jimenez | Physician Assistant | 267 Grant St, Bridgeport, CT 06610-2805 | 2020-05-01 |
| 1629608278 | Ethan Ramsey | Physician Assistant | 327 Medical Park Dr, Bridgeport, WV 26330-9006 | 2020-01-23 |
| 1336780709 | Christy Distasio | Physician Assistant | 267 Grant St, Bridgeport, CT 06610-2805 | 2019-10-07 |
| 1639616063 | Alison Robb | Physician Assistant | 267 Grant St, Bridgeport, CT 06610-2805 | 2017-01-24 |
| 1992155873 | Sabrina Butler | Physician Assistant | 267 Grant St, Bridgeport, CT 06610-2805 | 2016-06-21 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 26330 |
Please comment or provide details below to improve the information on RAETTA LYNN WENTZ.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.